Permit .
CITY OF TIGARD
a ELECTRICAL PERMIT
i . 2 CO MMUNITY DEVELOPMENT Per #: ELC2013 00134
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/25/2013
Parcel: 1 S134BD05100
Jurisdiction: Tigard
Site address: 11600 SW HAZELWOOD LP
Project: Egleston Subdivision: ENGLEWOOD NO.2 Lot: 139
Project Description: (1) 200 amps or less for panel change
' Contractor: PDX ELECTRIC LLC Owner: EGLESTON, TOM
7933 WHITFURROWS CT 11600 SW HAZELWOOD LP
DURHAM, OR 97224 TIGARD, OR 97223
PHONE: 503 - 997 -1989 PHONE: 541 - 912 -1142
FAX: 503 - 200 -1362
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 02/25/2013 $100.70
., Specifics: amps or less
1 ea 12% State Surcharge - 02/25/2013 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
•
Total $112.78
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through 0 R�5 -- 001 - -0090. You I�g obtain na a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. f o /
x
Issued By: d 2. /t�C fJ
Permittee Signature: Oki • 9Pe[— 0.` (' ' •
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE • Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
Thls permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
2/24/2013 6:30 PM From: PDX Electric LLC / 503 - 200 -1362 To: 15035981960 2 of 3
Electrical Permit Applicatio4CEIV D 1:N4 OFFIt 1'SF: ON1.vv
City of Tigard ,
Received ,
e- 13 St. Permit No.: ��( -(0 i 3
. • 13125 SW Hall Blvd., Tigard, OR 9722.E EB 2 5 2013
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 DateB : Other Permit:
T I , . A It f5 Inspection Linc: 503.639.4175 CITY OF TIGARD Date Ready /By: Juri.. 63 Sec Page 2 for
Internet: www.tigard i�LDINGDNISION Notified/Method: Supplemental Information
TYPE O RR PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check oil that apply (submit 2, sets of plans w!items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition El Other:
where the available Null current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use ogncultuml
® I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ 'A ", "E ", "I.2 ' l -3 ",
IOOHP or more. occupancy.
Job no.: Job site address: 11600 SW Hazelgood Loop
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard /OR/97223 ❑ Health -care facilities. ❑ Supply voltage for more than
_ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 I
l'ax map /parcel no.: Limited energy residential
DESCRIPTION OF WORK (with above J. R.) 75.00 2
Panel Change
Limited energy, multi- family 7500 1 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less I 100 70 1(10.70 2
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: Tom Egleston 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 11600 SW Hazeigood Loop Over 1,000 amps or volts 552.26 2
City/State/ZIP: Tigard /OR/97223 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (541)912 - 1142 Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: PDX Electric B. Fee for branch circuits without
- ---- -- service or feeder fee, first 56.18 2
Contact name: Marty Palmer branch circuit
Each add'I branch circuit 7.42 2
Address: 7933 SW Whitfurrows Ct Miscellaneous (service or feeder not included)
City/State/ZfP: Durham /OR/97224 Each manufactured or modula 67.84 2
dwelling, service and/or feeder
Phone: (503) 639 - 9708 Fax: : (503) 200 - 1362 Reconnect only 67.84 2
Pump or irrigation circle 67 84 2
E - mail: infonpdxelectric.com Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: PDX Electric panel, alteration, or extension. Page 2 2
• Each additional inspection over allowable in any of the above
Address: 7933 SW Whitfurrows Ct Additional inspection (I hr min) 66.25/ hr
investigation (1 hr min 66.25/ hr
City /State. /Z1P: Durham /OR/97224 )
_- ........_..._..._._._.. Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 639 - 9708 Fax: (503) 200 - 1362 Inspections for which no fee is 90.00/ hr
specifically listed (h hr min)
CCB Lic.: 192731 Electrical C' : 69 Suprv. Lic.: 5612S ELECTRICAL PERMIT FEES
/� Subtotal: 1 00.70
Suprv. Electrician signature, require
"CSI Plan review (25% of permit fee):
Print name: Marty Palmer n Date: 2 -22 -2013 State surcharge (12% of permit fee): 12.08
TOTAL PERMIT FEE: 112.78
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete. I
Print name: Date: • Number of inspections allowed per permit.
IaauildingPPermits \ELC- PermitAPp.doc 07/01(10 440.4615T(I I /05 /COM/WEB
2/24/2013 6:30 PM From: PDX Electric LLC / 503 - 200 -1362 To: 15035981960 1 of 3
PDX ELECTRIC
7933 SW Whitturrows Ct
Portland, OR 97224
(503) 639 -9708
(503) 200 -1362
www.pdxelectric.com
info @pdxelectric.com
To: Permits From: Marty Palmer
Fax: (503) 598 -1960 Date: 2/24/2013 6:29 PM
Phone: Re: PDX Electric- Permit Application
Comments
facsimile
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11600 SW HAZELWOOD LP, TIGARD, OR,
97223
Residential - Electrical
199 Electrical final
02/27/2013 00:00
ELC2013-00134
FAIL
No access 9:20am
Violation Summary:
Inspector Contractor